Article Text

PDF
A history of loss of consciousness or post-traumatic amnesia in minor head injury: “conditio sine qua non” or one of the risk factors?
  1. M Smits1,
  2. M G M Hunink2,
  3. P J Nederkoorn8,
  4. H M Dekker5,
  5. P E Vos6,
  6. D R Kool7,
  7. P A M Hofman9,
  8. A Twijnstra10,
  9. G G de Haan3,
  10. H L J Tanghe1,
  11. D W J Dippel4
  1. 1
    Department of Radiology, Erasmus MC-University Medical Centre, Rotterdam, the Netherlands
  2. 2
    Department of Radiology and Department of Epidemiology and Biostatistics, Erasmus MC-University Medical Centre, Rotterdam, the Netherlands
  3. 3
    Department of Medical Informatics, Erasmus MC-University Medical Centre, Rotterdam, the Netherlands
  4. 4
    Department of Neurology, Erasmus MC-University Medical Centre, Rotterdam, the Netherlands
  5. 5
    Department of Radiology, University Medical Centre Nijmegen St Radboud, Nijmegen, the Netherlands
  6. 6
    Department of Neurology, University Medical Centre Nijmegen St Radboud, Nijmegen, the Netherlands
  7. 7
    Department of Radiology, Academic Medical Centre, Amsterdam, the Netherlands
  8. 8
    Department of Neurology, Academic Medical Centre, Amsterdam, the Netherlands
  9. 9
    Department of Radiology, University Hospital Maastricht, Maastricht, the Netherlands
  10. 10
    Department of Neurology, University Hospital Maastricht, Maastricht, the Netherlands
  1. Professor M G M Hunink, Department of Radiology and Department of Epidemiology and Biostatistics, Erasmus MC-University Medical Centre, Rotterdam, the Netherlands; m.hunink{at}erasmusmc.nl

Abstract

Objective: A history of loss of consciousness (LOC) or post-traumatic amnesia (PTA) is commonly considered a prerequisite for minor head injury (MHI), although neurocranial complications also occur when LOC/PTA are absent, particularly in the presence of other risk factors. The purpose of this study was to evaluate whether known risk factors for complications after MHI in the absence of LOC/PTA have the same predictive value as when LOC/PTA are present.

Methods: A prospective multicentre study was performed in four university hospitals between February 2002 and August 2004 of consecutive blunt head injury patients (⩾16 years) presenting with a normal level of consciousness and a risk factor. Outcome measures were any neurocranial traumatic CT finding and neurosurgical intervention. Common odds ratios (OR) were estimated for each of the risk factors and tested for homogeneity.

Results: 2462 patients were included: 1708 with and 754 without LOC/PTA. Neurocranial traumatic findings on CT were present in 7.5% and were more common when LOC/PTA was present (8.7%). Neurosurgical intervention was required in 0.4%, irrespective of the presence of LOC/PTA. ORs were comparable across the two subgroups (p>0.05), except for clinical evidence of a skull fracture, with high ORs both when LOC/PTA was present (OR = 37, 95% CI 17 to 80) or absent (OR = 6.9, 95% CI 1.8 to 27). LOC and PTA had significant ORs of 1.9 (95% CI 1.0 to 2.7) and 1.7 (95% CI 1.3 to 2.3), respectively.

Conclusion: Known risk factors have comparable ORs in MHI patients with or without LOC or PTA. MHI patients without LOC or PTA need to be explicitly considered in clinical guidelines.

Statistics from Altmetric.com

Footnotes

  • Funding: This research was supported by a grant from College voor Zorgverzekeringen (CVZ: VAZ 01-104) and Radiologisch onderzoek Nederland (RADION). The authors’ work was independent of the funding organisations. The funding organisations had no involvement in the study design, data collection, analysis and interpretation, or in the decision to approve publication of the finished manuscript.

  • Competing interests: None.

  • Abbreviations:
    CCHR
    Canadian CT Head Rule
    GCS
    Glasgow Coma Scale
    LOC
    loss of consciousness
    MHI
    minor head injury
    OR
    odds ratio
    PTA
    post-traumatic amnesia

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.